Evaluating the role of preemptive intravenous ketorolac in preventing post-operative pain in patients undergoing hemorrhoidectomy: A randomized clinical trial.

BACKGROUND

Post-hemorrhoidectomy pain remains a common and distressing factor that negatively affects the patient's recovery and satisfaction following the operation. Preemptive analgesia is a therapeutic measure before surgery initiation to prevent central sensitization and reduce the postoperative pain in the early period.

OBJECTIVE

To evaluate the preemptive effect of intravenous ketorolac on pain severity in patients post-hemorrhoidectomy.

METHODS

In this randomized clinical trial, 61 adults scheduled for hemorrhoidectomy were allocated to receive either 30 mg intravenous ketorolac just before induction (intervention group) or no preemptive analgesic (control). Both groups received postoperative pethidine as needed for breakthrough pain. Pain severity was assessed at 1 and 4 h postoperatively using the verbal rating scale (VRS), and postoperative opioid consumption was recorded.

RESULTS

32 out of 61 patients were enrolled in the intervention group and 29 in the control group. There was no difference in age or sex between the two groups (p > 0.05). The results showed that pain severity in the 1st and 4th hours after the operation was significantly lower in the intervention group (p < 0.001). Also, the postoperative demand for opioids was significantly lower in the intervention group (p = 0.002).

CONCLUSION

We found that NSAIDs, particularly ketorolac, can be used as preemptive medication to reduce postoperative pain and decrease the use of opioids. This might lead to a decrease in the side effects of opioids. However, further evaluations with larger populations and longer follow-up periods are essential. This randomized clinical trial registration code is IRCT20240808062692N1.